Rheumatoid arthritis (RA) is a multisystem autoimmune disease associated with considerable morbidity and mortality worldwide. African Americans (AAs) have been markedly underrepresented in research on RA. The strong association between lower levels of individual socioeconomic status (SES) with poorer health outcomes in RA is well-established in whites, but less so in AAs. Recent data suggest that community social determinants, e.g., the socioeconomic environment of an individual's neighborhood and environmental exposures, may be operant in this regard, as well. In addition, racial segregation sorts individuals of comparable SES into vastly different neighborhood environments. AAs are often segregated from the white population, which may result in community influences differing for AAs and whites. The long-term goal of this proposal is to examine the relationship of social determinants across the lifecourse with health outcomes in AAs with RA. This project will be the first study to examine individual and community-level social determinants in an AA population with RA, by examining social position (childhood, current and lifecourse individual-level SES) and social context (community-level SES, environmental exposures, access to services and racial residential segregation). It will also be the first to examine perceptions (control, discrimination and neighborhood) that may act as mediators of outcomes in RA. The proposed project will be conducted using extensive demographic, socioeconomic, environmental, clinical and radiographic data collected through the Consortium for the Longitudinal Evaluation of African Americans with Early RA (CLEAR) registry and network, which consists of a Coordinating Center at the University of Alabama (UAB) and clinical sites at UAB and 4 other universities across the southeast. CLEAR has two components: CLEAR I with 350 AA participants with <2 years of disease duration who are already enrolled and will be followed to year 5 of their disease;and CLEAR II with an anticipated 600 AA RA participants of any disease duration who are currently being enrolled for a single cross-sectional examination. Specific aims include: 1) To evaluate associations between social position across the lifecourse with disease severity in AAs with RA, 2) to determine whether there are independent associations between social context and social position across the lifecourse with disease severity in AAs with RA, and 3) to test hypothesized mediators in the relationships between social position (across the lifecourse) and social position with disease severity in AAs with RA. PUBLIC HEALTH RELEVANCE: African Americans have been markedly underrepresented in research on rheumatoid arthritis (RA), so there are many important unanswered questions regarding the disease in this racial/ethnic group. This project aims to clarify the role social determinants with health outcomes in African Americans with RA, and is the first to examine socioeconomic status issues specifically in an African American population with RA. A better understanding of these issues will provide an invaluable foundation for designing clinical interventions and creating policies to reduce these gaps.